Status:
Ready to upload
Record number:
1739
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
N/A. This case constitutes the second example of an anti-K19 that caused a delayed hemolytic transfusion reaction.
Time to detection:
10 days
Alerting signals, symptoms, evidence of occurrence:
A 47-year-old black man had been transfused without complications several times in the past following an injury. He was transfused again with four units of Rh negative red blood cells (RBC), which raised his hematocrit to 35 per cent. Compatibility tests and antibody screening procedures had been negative until this time. He was readmitted to the hospital ten days later when his hematocrit was 26 per cent, reticulocytes 11.7 per cent, serum bilirubin 3.25 mg/dl (indirect 2.25 mg/dl) serum LDH 589 mU/ml, alkaline phosphatase 114 mU/ml, SGOT 72 mU/ml, and haptoglobin was absent. Antibody screening tests were strongly positive and anti-C and anti-K19 were identified in his serum. The direct antiglobulin test (DAT) was negative, indicating that all of the K19 RBC transfused ten days earlier had been eliminated from his circulation.
Demonstration of imputability or root cause:
It was concluded that the patient had been sensitized by previous transfusions without detectable antibody and had anamnestic response to the blood transfused at the beginning of this episode. As a result, he suffered a delayed hemolytic transfusion reaction confirmed by the serologic results obtained. Hepatic disease secondary to alcohol intake may also have contributed to the laboratory findings. Although his serum also contained anti-C, the stimulus for which is unknown, he was given Rh negative blood and the anti-C antibody can be exonerated.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest references:
Marsh WL, DiNapoli J, Oyen R, Greenspan R, Hu A, Rincon F. (1979). Delayed Hemolytic Transfusion Reaction Caused by the Second Example of anti-K19. Transfusion Sep-Oct;19(5):604-608.
Expert comments for publication:
The antibody identified constitutes the second example of anti-K19 that caused a delayed hemolytic transfusion reaction. No other examples have been later reported. K19 is a high-incidence antigen of the Kell blood group system.